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Psychiatric Comorbidity in Epilepsy 

Psychiatric Comorbidity in Epilepsy
Psychiatric Comorbidity in Epilepsy

Marco Mula

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date: 26 June 2022

Psychiatric disorders represent an often-encountered comorbidity, especially in patients with refractory epilepsy, affecting prognosis, morbidity, and mortality. In general terms, it is important to distinguish symptoms that may accompany seizures (i.e. peri-ictal psychiatric symptoms) from a true psychiatric phenomenology. This point has relevant implications in terms of prognosis and treatment, being seizure control is essential in the first case. Adequate guidance of treatment for comorbid psychiatric disorders is still limited. In general terms, internationally adopted guidelines of treatment outside epilepsy may be considered taking into account a number of issues related to the underlying brain disorder, namely pharmacokinetic interactions with antiepileptic drugs and seizure risk. The present chapter is focused mainly on mood and anxiety disorders and psychoses, discussing major clinical presentations and treatment options. In general terms new psychotropic drugs, both antidepressants and antipsychotics, are better tolerated than older drugs and reasonably safe in patients with epilepsy. SSRIs, especially citalopram, are considered first line agents in mood and anxiety disorders and new antipsychotics, especially olanzapine, quetiapine and risperidone, in interictal psychoses. The potential for drug interactions is generally minimized although drug dosages need to be adjusted according to clinical response in patients taking inducers (e.g. carbamazepine, barbiturates or phenytoin). Long term tolerability needs to be considered with special attention to the possibility of weight gain, sedation, and quality of life.

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